Consent for Use of Personal Information

By clicking “Sign Up” below, I certify that I am 18 years of age or older and authorize Incyte Corporation (“Incyte”) and its agents to use my registration information provided above (my “information”) to contact me in order to provide education and ongoing support services related to product, disease and other areas of interest. I understand that I may at any time revoke my consent to be contacted for any of these purposes by opting out from future communications from Incyte. I also understand that the information I provide may be combined with that of other registrants to create aggregated, anonymized data and to use and share only the anonymized data for any legitimate business purpose. Learn more about how Incyte processes your personal information at Privacy Policy.

U.S. State Law Consent to Health Data Use for Patient Support Programs

I consent to Incyte collecting, using and disclosing my health data for the following purposes:

• To enroll me and manage my participation in Incyte’s GVHD CRM Program, which includes activities related to my condition or treatment (for example, co-pay card programs, payer medication coverage verification, nurse educator support, disease management support), and to manage Incyte’s products, services, and programs related to my condition or treatment.

Incyte uses the following when it administers the Incyte GVHD CRM Program:

• Health data – my name (and the name of my caregiver if applicable), gender, date of birth, contact information and information relating to my health condition or treatment.

I understand that my consent to this use of my health data is required for me to participate in the Incyte GVHD CRM Program. I also understand that Incyte will not sell my health data to third parties, but Incyte may disclose my health data to Incyte’s vendors only for Incyte’s business purposes related to the Incyte GVHD CRM Program. I understand that Incyte may use my health data to contact me by email, for the above purposes. I also understand that if I do not consent to the use of my health data for the above purposes, I will not be able to participate in the program. Finally, I understand that I may withdraw my consent to processing my health data for the above purposes at any time by calling 1-855-446-2983 or visiting https://www.incyte.com/privacy-policy and that if I withdraw my consent, I will no longer be able to participate in the program. I understand that this consent will remain in effect for one year.

By signing above, I am indicating that I am legally authorized to consent and that I am providing my consent as the patient or the patient’s legal guardian for Incyte to collect, process and disclose my health data I provide for the purposes described within the Consent above.